Sex After a Cancer Diagnosis
- Molly Kochan, who passed away at age 45 from metastatic breast cancer in 2019, embarked on a journey of intimacy and sex while living with the disease—offering inspiration for others battling cancer to live their lives to the fullest.
- Kochan was first diagnosed with breast cancer that spread to her lymph nodes in 2011, which led her to undergo chemotherapy, radiation treatment and get both of her breasts removed (double mastectomy). In 2015, when the cancer spread to her brain, liver, and bones.
- Metastatic breast cancer, also called “stage four” breast cancer, occurs when the cancer has spread, or metastasized, beyond the breasts to other parts of the body. It most commonly spreads to the bones, liver and lungs, but it may also spread to the brain or other organs.
- While treatment for metastatic breast cancer is not curative, it can improve your quality of life. You and your doctor will work together to develop a treatment plan that’s right for you.
- Treatments for certain cancers do affect the hormones and can cause many changes when it comes to libido, sexual function, and body image.
- However, a healthy sex life is possible after cancer treatment and there are many products made specifically for people who have undergone treatment. Check out this episode of “SN & You,” where cancer survivors get candid about how treatment affected their sex lives and relationships.
Kochan was first diagnosed with breast cancer that spread to her lymph nodes in 2011, which led her to undergo chemotherapy, radiation treatment and get both of her breasts removed (double mastectomy). However, in 2015, when the cancer spread to her brain, liver, and bones, Kochan turned to sex to cope.
Read MoreAdditionally, a comedy drama miniseries called “Dying for Sex” premiered this month for FX on Hulu, starring Michelle Williams. It’s based on the podcast featuring Kochan’s stories and sees Kochan’s beloved friend Niki Boyer as the executive producer.
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Speaking in one of her podcast episodes, Kochan previously admitted that her and her husband had sexual “difficulties” prior to her diagnosis.
“Right before I got diagnosed, I was kind of looking to recharge our sex life… and then cancer showed up,” she explained.
She also said on her podcast, as per LAD Bible, that the hormone therapy she had underwent left her with a heightened libido, which led her to made a change in her life.
Kochan admitted she “never really knew what she liked” when it came to intimacy in the bedroom, saying on her podcast, “For a long time with sex, and this is why I had a problem in my marriage, I was really, really, really good at figuring out what other people liked and then I could simulate that like an actor for them. But I never really knew what I liked.”
She also wrote in a March 2016 blog post, after breaking it off with her husband, “Sure it takes two to make or break a marriage. It’s technically sad when a union of 13 years dissolves. Things that look good on the outside are not always that way on the inside…I could go on…but I won’t. At least, not in this direction.
“The truth is, without this diagnosis I probably would have stayed, continued to try to make things work. Because there is a lot of love there. But there is also a lot of stress. And a stressful environment is not a good one when battling cancer.”
Kochan continued, “It is this real knowing of the finite nature of life that has pushed me to seek joy. Nurture self expression that I couldn’t find in the context of my marriage. It’s allowing me to stop second guessing that voice that has been telling me I’m unhappy.
“Because even though there were good times, I never quite felt reflected in my surroundings. It was like I was renting space in someone else’s world. And it’s time to live in mine.”
RELATED: Sex & Intimacy: Getting Into the Overlooked Side Effects of Cancer Treatment
Prior to her passing, Kochan reportedly said on her podcast, “Sex makes me feel alive, and it’s a great distraction from being sick.
“I don’t think I would do any of this stuff without the cancer. Even though I’d maybe want to, I’d be a little more cautious about everything.”
Boyer, Kochan’s friend and exec producer of “Dying for Sex,” told The Times in a recent interview, “A lot of people think, ‘She’s just having sex, f***ing around to make herself feel good.’ But it wasn’t just about that.
“There was healing of old wounds. Her whole life she felt fragmented and during sex she was allowed to make her own choices and put the pieces together for herself.”
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Boyer continued, after pointing out how she and Kochan stopped counting how many people she had sex with when she reached 183, “She made people feel seen and cared for. It was about a lot more than the sex for Molly/ Towards the end I think she was looking for love.”
However, she recounted Kochan writing the following prior to her passing, “I wish I could cap off the whirlwind hospital story with an amazing tale about a guy who swept me off my feet and made me blush, but my visitor never showed up.
“I realise I did get to fall in love. I am in love. With me.”
Understanding Metastatic Breast Cancer
Breast cancer spreads through the bloodstream or lymphatic system. The blood carries cancer cells to different body parts, where they grow as new tumors.
Once breast cancer spreads, the cells may continue to grow slowly or stop growing and stay at equilibrium.
“Metastatic breast cancer is a treatable disease,” explains Dr. Kenneth D. Miller, medical oncologist at the Alvin & Lois Lapidus Cancer Institute at Sinai Hospital of Baltimore.
“Fortunately, we have so many new treatments for women with recurrent breast cancer and for many women who look at this as a chronic disease that they can live with often for many years.”
When Breast Cancer Spreads to the Bones
Breast cancer is sometimes classified as either local, regional, or distant.
- Local: Cancer is located in the breast and has not spread
- Regional: Cancer spreads from the breast to nearby lymph nodes
- Distant: Cancer spreads to distant parts of the body, including bones, liver, lungs, and/or brain
Treatment for metastatic breast cancer focuses on decreasing the spread of cancer cells, as well as relieving symptoms and improving quality of life.
Sex After Cancer: How Women Can Connect the Body & Mind
It’s important to understand that many women experience sexual side effects both during and after treatment for various types of cancers, but most won’t address the topic with their doctors.
Not speaking out to their doctors could be because they feel embarrassed, uncomfortable, or because there’s simply so much going on during treatment, that women forget to think about sexual health.
Sex After Cancer: What’s the Difference Between Lubricant and Moisturizer?
Remember, it’s important for patients to understand that a healthy sex life is attainable after facing cancer, though it may look a little different.
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Memorial Sloan Kettering clinical health psychologist and sexual health therapist Dr. Jeanne Carter previously explained to SurvivorNet that many women who experience sexual issues feel ashamed because they don’t understand how common these problems are.
“Patients actually feel like it’s just them, that no one else is having these issues,” Dr. Carter said. “So, I think it’s important for healthcare providers to raise the topic so it can normalize their experience, as well as give them an avenue to get information and support.”
When it comes to physical discomfort, as some cancer treatments can lead to menopause or menopause-like symptoms, the sexual side effects can result in emotional and physical pain.
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- Sex After Cancer: What’s the Difference Between Lubricant and Moisturizer?
- Sex After Cancer: Learn How This Amazing Survivor Overcame Years of Suffering to Finally Have Sex Without Pain, or Shame
- SN & You: Discussing Sex and Sexuality After Cancer
Therefore, any discomfort felt amid sex or sexual activity can quickly prompt a loss of sexual excitement. Dr. Carter made it a point to stress the importance of using lubricants and moisturizers.
Dr. Carter explained, “A lot of times people feel like lubricants are the solution, and they are part of the solution, but they are not the entire solution. When you don’t have estrogen, you usually are not having moisture in the vagina, as well as on the vulva.”
It’s important to make sure the vulva, or the external part of a woman’s genitals, is well-moisturized as well, Dr. Carter said. There are options for both non-hormonal moisturizers and low-dose estrogen moisturizers. Dr. Carter gave examples of a few non-hormonal products that work well for many women—like Hyalo Gyn, Replens, Revaree— and noted that women dealing with cancer side effects will usually need to moisturize more often.
SN & You: Discussing Sex and Sexuality After Cancer
“We find that women need to moisturize more in the cancer setting, like 3 to 5 times per week, whereas the product instructions will tell you to only use it 2 to 3 times a week and only in the vagina,” Dr. Carter added.
As for the emotional aspect of it, Dr. Carter explained, “Sexuality is physical and emotional and they’re completely enmeshed, so you can’t really treat this without addressing both of those issues.
“I think women going through a cancer experience are just really trying to make sense of what their body is going through.”
Whether you are mourning the loss of a body part, like breasts after a mastectomy, or trying to find the confidence to date again after treatment, there is support and guidance available.
Gynecological nurse practitioner Ashley Arkema also spoke to SurvivorNet on sex after cancer, advising, “I just encourage people to explore on their own some. Sometimes people say that they have a lack of interest, but a lot of times the lack of interest is directly correlated to the pain.
“If sex over time is painful over and over again, then you start to develop a negative association with it. So, I usually try to encourage people to explore on their own or limit activity to external stimulation until they feel like they’re able to tolerate penetrative sex.”
From trying new things in the bedroom to seeking the guidance of a therapist or peers in a support group, there should be options for women seeking all different types of support.
Dr. Carter and Arkema both stressed that women dealing with any sort of sexual side effects can find help, but the solutions will take some time and take some getting used to.
“A lot of these changes [to the body] happen very quickly and I think people are ready at different times to be ready to address it,” Dr. Carter said. “So, we always start with the physical stuff, because I think it actually slows women down to really treat these symptoms and connect with their body in a positive way because they’re healing and nurturing.
“There’s a lot to be said about that. Taking time and effort to actually pay attention to these areas and to touch these areas and to try to heal these areas I think wakes up something for women that there’s a part of their body that maybe they weren’t paying attention to.”
Sex & Intimacy
Sex is something that’s often overlooked when it comes to cancer treatment. Doctors are so focused on keeping patients alive, that the sexual side effects that come with cancer treatment aren’t really factored in as an important part of the equation. This is an issue that comes up often when we interview both male and female survivors.
But cancer can also open up doors to exploring your body in a way you never have before. Breast cancer survivor Ericka Hart said anyone worrying that they may never have sex again after facing cancer, really shouldn’t.
Kink and BDSM can be a ‘beautiful way to reclaim your body,’ says survivor Ericka Hart
“If you’ve just been diagnosed and you are thinking you’re never going to have sex again, think again,” Hart said, sharing that it helped her learn a new sexual avenue.
“Kink and BDSM was a huge part of my healing. When you go through breast cancer, it’s almost like a non-consensual pain you’re going through … but to have someone spank you, or flog you, or even choke you in a consensual way that you’re asking for can be a really beautiful way to reclaim your body.”
RELATED: “I Just Want to Have Sex Again” Life After Treatment
Expressing fantasies, watching adult films together — from the highly tasteful to the taboo — and reading erotic poetry or literature are other ways to spice up your sex life as a couple (or to explore individually).
If single, online dating may open up opportunity for virtual communication sexually. Some feel more fulfilled just having an emotional connection with someone, even if the person is across the world.
Watch: SN & You: Discussing Sex and Sexuality After Cancer
Coping With Body Image
It’s common for cancer survivors to struggle with the physical part of their own health journey, clinical psychologist Dr. Marianna Strongin previously told SurvivorNet.
“Your body has changed and represents this difficult chapter in your life and simply accepting all of that is far too simple,” said Strongin.
To help combat these feelings, Strongin suggests to spend time in front of the mirror looking at the parts you truly love, adding, “Give them time, honor them and then thank them.”
Strongin then says to spend time looking at the part (or parts) of your body that have been impacted by cancer or disease, such as your chest where your breasts have been removed, or your head where there is no longer hair.
Celebrity Stylist Ann Caruso says dressing your best can make you feel better while going through cancer.
“At first you may experience a flood of emotions — this is expected and normal. As you allow yourself to spend more time looking at all of you, you will begin having a new relationship with your body,” Strongin explained.
“It may not happen immediately, but with time you can begin honoring and thanking that part of your body by creating a more accepting relationship with yourself.”
Questions to Ask Your Doctor
- What are the potential side effects of my cancer treatment?
- What kind of products can I use to help improve my sex life?
- Is there anything my partner should be aware of before we are intimate?
- What can I do if I feel self-conscious or frustrated about changes to my body?
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
